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Party Drugs: Dancing the Night Away Part 2
by Jeff Kopito, EMT-D
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Note: This is Part 2 in a three-part series on party drugs. The final Part 3 of the series will look at GHB and ketamine. Part 1 can be found here. |
Originally synthesized and later patented in Germany by Merck in 1914, MDMA was thought to have some appetite-suppressant possibilities. However, Merck never moved forward with clinical trials, and the drug was eventually abandoned. Although it was never brought to market, legend has it that during the 1950s the US Army briefly investigated it for possible military applications as part of its chemical warfare program.1
The drug remained largely forgotten until the 1960s, when Alexander Shulgin, a successful research chemist for Dow Chemical, began his own investigations of the phenethylamine family of drugs. He and Dow eventually parted ways over this research, and Shulgin went on to catalog more than 179 psychoactive drugs, including MDMA. Shulgin, in fact, is reputed to have been the first human to have tried MDMA and often has been referred to as the "Father of Ecstasy."
By the 1970s, MDMA, now under the name Ecstasy, was being used by members of the psychotherapeutic community who were familiar with the possible therapeutic effects of hallucinogenics. The drug eventually found its way to the general population, where its potential for abuse as well as reports of its possible neurotoxicity brought it to the attention of drug and law enforcement authorities. Although researchers sued the US government to prevent a ban on Ecstasy, it was eventually outlawed and branded a Schedule I drug in 1985 by the Drug Enforcement Administration, putting MDMA into the same class as heroin.
Therapy specialists are still lobbying for clinical trials, claiming that MDMA can be used in cases of depression, post-traumatic stress disorder, and anxiety where dose and quality of the drug can be controlled. Dr. Charles Grob, MD, chief of child psychiatry at the University of California at Los Angeles, is also interested in examining how the drug can help terminal cancer patients deal with anxiety and depression.2
But as more research is done, there is greater evidence to support possible permanent brain damage in users, including short-term memory problems, cognitive difficulties, insomnia, and anxiety. Interestingly, in a recent report on MDMA toxicity in The Lancet, the researchers found a higher incidence of destruction of serotonin transporters in the brain among female users, as opposed to men.3
Street dosage and administration
Although Ecstasy can be bought in several forms, it is ordinarily taken as a pill. The standard dose is approximately 80-150 mg, with the primary effects lasting up to four hours.
Many pills claiming to be Ecstasy are exclusively ephedra, caffeine, or methamphetamine, or have been adulterated with these stimulants. These pills mimic the amphetamine-like effects of Ecstasy without the empathetic responses. Ephedra is also sold as "herbal ecstasy."
Ecstasy users have also been documented to combine the pills with alcohol, Rohypnol, LSD, Viagra, cocaine, benzodiazepines, cough syrup, and opiates other than heroin.4
Signs and symptoms of use
Since the effects of the drug wear off quickly, users tend to take more of the drug and in higher doses. This leads to paranoia, restlessness, and anxiety. Ecstasy users are also warned about dehydration so they often drink copious amounts of water. This can cause severe imbalances of electrolytes in the blood, creating a condition known as hyponatremia (literally "low sodium"). These electrolyte disturbances can lead to stupor, vomiting, and diarrhea. In rare cases, they also cause swelling of the brain, seizures, and death.
There is also a greater chance of injury when the user has a history of heart disease such as high blood pressure, aneurysm or stroke, glaucoma, liver or kidney disorders, or hypoglycemia.
Adverse reactions to MDMA can occur in patients who are also taking monoamine oxidase (MAO) inhibitors, which include Nardil, Parnate, Marplan, Eldepryl, and protease inhibitors such as Ritonavir. The use of MDMA with these drugs can cause "serotonin syndrome." This is a potentially fatal condition that shows such signs as hyperthermia, tremors, hyperreflexia, ataxia, and altered mental status.
Treatment
Since there is no antidote, prehospital care is basically supportive. Monitor the patient's ABCs carefully and periodically check level of consciousness and vital signs. If severe dehydration is suspected, obtain IV access and provide fluids. If a patient is complaining of chest pain, initiate cardiac monitoring and provide oxygen.
Hyperthermia is common; if evident, begin cooling measures based upon local protocols. Seizures can be controlled with sedatives such as benzodiazepines. As always, follow your local protocols.
It's important to understand that the variety of drugs that may have been taken with Ecstasy can cloud the treatment alternatives. Try to gather as much information as possible from either the user or others on-scene who may know what the patient has taken.
Rohypnol
(Flunitrazepam)
Rohypnol, a member of the benzodiazepine family, is a highly effective sedative that is about 10 times more powerful than an equivalent dose of Valium. Wearing the notorious title of "date rape drug," Rohypnol is actually a tranquilizer sold worldwide outside the US as a sleep aid and presurgical sedative. Manufactured by Hoffman-LaRoche, it is listed as a Schedule IV drug in the US. Since the FDA does not approve it for human consumption, it is illegal to possess, prescribe, or manufacture.
Rohypnol's reputation comes from one of its effects — anterograde amnesia — that prevents the user, or unwitting victim, from remembering any of the events occurring while under the influence of the drug. Although that reputation may be deserved, Rohypnol is actually rarely used for this purpose. In fact, in a study published in the Journal of Reproductive Medicine, approximately 2,000 urine specimens taken from sexual assault victims showed that GHB (gamma hydroxybutyrate) and Rohypnol turned up in less than three percent of the samples.5
Rohypnol is generally found in blister packs of 10 in 1-mg tablet doses. The most common dose is between 0.5 and 2 mg. Sensitive to its abuse as a furtive additive to alcoholic drinks, and the fact that Rohypnol is odorless, tasteless, and dissolves easily in liquids, Roche has reformulated the tablet so that it dissolves more slowly while releasing a blue dye that discolors the drink it's dropped into. Roche has also phased out its highest formulation 2-mg tablet.
| Date Rape Drugs |
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Although Rohypnol has achieved the notorious reputation
as a date rape drug, it doesn't have exclusive rights. In
fact, The American Prosecutors Research Institute classifies
22 different drugs that are used to facilitate rape in
unsuspecting victims. This list includes Rohypnol, GHB, benzodiazepines, Ketamine, Benadryl, and even Burundanga, plant sourced sedative-hypnotic scopalamine, manufactured from the Datura arobrea tree in Colombia. Also used in this type of sexual assault are Xanax, Valium, and even the sleep aid Ambien. To avoid becoming a victim, follow these guidelines:
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Rohypnol rarely travels alone. It is usually mixed with alcohol to enhance the feeling of drunkenness. Unfortunately, this combination is also the most lethal, since it increases the effects of central nervous system depression. Onset of effects from an initial dose ranges from 15-30 minutes, peaks within two hours, and lasts approximately six to eight hours.
Rohypnol is used by heroin addicts in combination with low-grade heroin and also following a cocaine binge to blunt the edge of the "crash," known as "parachuting." The drug is also commonly mixed with Ecstasy, which contributes to its label as a "club drug." Like the other members of this family, Rohypnol can create drug dependence, with withdrawal effects such as seizures, hypertension, tremulousness, and diaphoresis.
The effects of taking the drug include:
Because it is a central nervous system depressant, Rohypnol mixed with alcohol or other narcotics can have serious implications, such as respiratory suppression, coma, and apnea. But it is precisely this mixture of other drugs that makes diagnosis and treatment difficult.
Following a known overdose (depending on local protocols), vomiting should be induced within one hour of ingestion. Beyond one hour, activated charcoal can be used to reduce absorption.
The specific benzodiazepine antagonist is flumazenil (Mazicon, Romazicon), and is generally used in a hospital setting.
When possible, it is imperative that a complete history be taken, either from the patient or from others on the scene who may have knowledge of abuse.
References (*All links in References will open in new windows.)
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